About Antimicrobial Resistance Investments & Action

Overview

CDC invests in national and global infrastructure to detect, respond, contain and prevent antimicrobial-resistant infections across healthcare settings, communities, the food supply and the environment to protect people and save lives through the Antimicrobial Resistance Solutions Initiative (AR Solutions Initiative).

Funding through CDC's AR Solutions Initiative supports all 50 state health departments, five local health departments, and health departments of three territories. CDC also collaborates with other federal agencies, state and local health departments, patients, public health partners and the private sector to address this threat.

CDC implements activities in support of the U.S. National Action Plan for Combating Antibiotic-Resistant Bacteria.

Combating AR in health care

CDC invests in healthcare systems to make them safe places for patients to receive care. CDC expertise and resources have helped implement healthcare programs to prevent healthcare-associated infections (HAIs), including antimicrobial-resistant infections, and control the spread of germs. Germs that cause HAIs, including germs that are antimicrobial-resistant, can spread from patient to patient and across healthcare facilities through patient transfer. When not stopped, resistant healthcare-associated germs can spill over into communities, becoming much harder to control.

Hospital infection prevention and control programs have proven to be effective. For example, CDC's Containment Strategy—a series of aggressive detection and response activities—works to stop new or rare forms of antimicrobial resistance (AR) from spreading. For the "nightmare bacteria" CRE alone, aggressive containment responses could prevent 1,600 cases in just one state over three years.

The 2019 Antimicrobial Resistance Threats Report shows that nationwide investments in prevention drove down deaths from antimicrobial-resistant infections from 2012 through 2017. Additional data shows these reductions continued until 2020 when the U.S. started losing progress combating antimicrobial resistance due to effects of the COVID-19 pandemic. The pandemic resulted in more resistant infections, increased antibiotic use, and less data and prevention actions.

In Antimicrobial Resistance Threats in the United States, 2021-2022, published in July 2024, new dataA show that six bacterial antimicrobial-resistant hospital-onset infectionsB increased by a combined 20% during the COVID-19 pandemic compared to the pre-pandemic period, peaking in 2021, and remaining above pre-pandemic levels in 2022. In addition, the number of reported clinical cases of Candida auris (C. auris) - a type of yeast that can spread in healthcare facilities, is often resistant to antifungal medications, and can cause severe illness - increased nearly five-fold from 2019 to 2022. These data show that additional action is critical. We can and must do more to combat antimicrobial resistance by investing in and supporting the prevention-focused public health actions that we know work, including effective infection prevention and control, accurate laboratory detection, rapid response, appropriate antibiotic and antifungal use, and innovative prevention strategies.

Combating AR in the environment

Addressing antimicrobial resistance in the environment (e.g., water, soil) is a key part of using a One Health approach to combat this threat. CDC is addressing how resistance emerges and spreads in the environment, and how it can be a potential risk to human health. Traces of antibiotics and antifungals, germs resistant to them and genes that cause resistance traits are present and can spread in waterways and soils. However, scientists do not fully understand the risk of resistance in the environment on human health. Learn more about how antimicrobial resistance can spread in water and soil.

Combating AR in animals

Animals, like people, can carry antimicrobial-resistant germs. The American food supply is among the safest in the world, but people can still get sick from foodborne infections. People can also get sick from having contact with food or companion animals. CDC is working to detect, respond, contain, and prevent resistant infections to protect people and save lives. Learn more about how resistance can spread in the food supply.

Combating AR by investing in laboratory networks

Laboratory tests can help guide patient treatment, detect emerging threats, and prevent the spread of antimicrobial resistance. CDC's Antimicrobial Resistance Laboratory Network and Global Antimicrobial Resistance Laboratory and Response Network support lab testing in health care, the community and the environment (e.g., water, soil). This work ultimately improves patient care, enhances public health, and informs solutions against resistance threats.

Combating global AR

Antimicrobial resistance has been identified in all regions of the world. CDC is leading the public health fight as the U.S. continues to take a global One Health approach to combat antimicrobial resistance. CDC supports activities in more than 60 countries to improve antibiotic and antifungal use, track resistance and implement infection prevention and control activities. Learn more about how antimicrobial resistance can spread across the world.

Program Impact

Since 2016, CDC has invested in more than 700 innovative antimicrobial resistance projects in more than 60 countries to slow the spread of resistance domestically and globally. Through these investments and partnerships, CDC is transforming how the nation and world combat and slow antimicrobial resistance at all levels.

Tracking and data

National tracking

CDC strengthens national tracking of AR by:

• Establishing and strengthening national tracking systems to respond rapidly to outbreaks, identify emerging pathogens, and track trends.
• Using CDC's National Healthcare Safety Network (NHSN) to track and report resistant threats and antibiotic/antifungal use across healthcare settings like hospitals and long-term care facilities.
• Using CDC's AR Lab Networks to close the gap between local capabilities and the data needed to detect known and emerging antimicrobial resistance by providing data to drive response and prevent infections.
• Performing whole genome sequencing on tens of thousands of isolates (pure samples of germs) for fast identification of antimicrobial-resistant outbreaks and to track overall trends in resistance using CDC's National Antimicrobial Resistance Monitoring System (NARMS).
• Gathering more infection data from healthcare facilities to better measure the challenges influencing healthcare quality and patient safety and implement solutions.
• Sharing whole genome sequencing data with state, local, and federal agencies through the System for Enteric Disease Response, Investigation, and Coordination (SEDRIC) information technology platform during outbreaks.
• Using CDC's AR Lab Network to strengthen and support nationwide laboratory testing capacity to identify known and emerging antimicrobial-resistant pathogens (germs) quickly and accurately. When labs detect dangerous pathogens, the network supports rapid communication with appropriate partners to control the threat and protect people.
• Improving the speed and efficiency of antimicrobial resistance data electronically transmitted from AR Lab Network laboratories to CDC through the Data for Action on Antimicrobial-Resistant Threats (DAART) portal. CDC is also working to improve the format and usability of data shared with antimicrobial resistance pathogen subject matter experts.

Food supply safety

CDC develops food supply safety from AR by:

• Expanding monitoring of antimicrobial resistance data from animals, farms and production facilities.
• Using outbreak data to increase understanding of foodborne resistant germs to improve food safety.

Community safety

CDC ensures community safety from AR by:

• Supporting predictive analytics to track and prevent the spread of antimicrobial resistance within communities.

Environment and sanitation

CDC strengthens environmental and sanitation AR data by:

• Establishing new ways to collect antimicrobial resistance data from the environment, including water and soil, to better understand its impact on human health.

Prevention and containment actions

National support

CDC strengthens national support of AR by:

• Increasing CDC's investments in state and local infrastructure to address antimicrobial resistance locally.
• Supporting nationwide lab capacity through CDC's AR Lab Network to detect antimicrobial resistance rapidly and inform local responses to prevent spread and protect people by:
  • Providing technical expertise, including developing new tests, guidance and tailored solutions.
  • Supporting prevention experts, programs and training.
  • Reporting critical findings to international partners.
• Supporting efforts to keep new or rare forms of antimicrobial resistance from spreading through CDC's Containment Strategy.
• Coordinating with local and state public health departments to inform outbreak response.
• Providing resources and expertise for outbreak response, infection prevention and control, and laboratory detection of germs.
• Providing Infection Control Assessment & Response in healthcare facilities to identify and address gaps in infection control that could lead to the spread of germs.
• Enhancing infection control to prevent spread of germs, including evaluating cleaning methods and measuring the impact of setting-specific strategies (like strategies developed specifically for nursing homes).
• Screening groups at risk for tuberculosis and gonorrhea to prompt treatment and prevent resistant infections.
• Improving infection prevention and control by providing education and guidance for safer sex practices and safe food handling and preparation.

Health care

• CDC strengthens prevention and containment of AR in health care by:
  • Implementing hospital infection prevention programs and other activities, hospitals saw a 27% reduction of antimicrobial-resistant infections and a 30% reduction in associated deaths from 2012-2017.
  • Testing 253,000+ swabs to detect resistant germs in health care—many of these launched a public health response.More than 97% of acute-care hospitals report having an antibiotic stewardship program meeting CDC's Core Elements.

Environment and sanitation

CDC grows prevention and containment of AR in the environment by:

• Supporting investigators to sample surface water for human and agricultural waste and antimicrobial-resistant germs.
• Detecting and determining the amount of resistance elements (mechanisms like a gene that can share resistance) in discharged wastewater and soil, and the effectiveness of wastewater treatment systems.
• Investigating how antimicrobial-resistant bacteria from concentrated poultry farms may impact aquatic ecosystems.
• Studying antimicrobial-resistant bacteria generated during wastewater treatment and evaluating the risk of exposure, colonization and infection to treatment plant workers.
• Investigating the role wastewater plumbing in healthcare facilities play in the survival and spread of antimicrobial-resistant bacteria in patient care areas.

Food supply

CDC provides prevention and containment of AR in the food supply by:

• Studying the effect of azole use (an antifungal drug) on crops to contain the spread of azole-resistant Aspergillus fumigatus.
• Expanding domestic capacity to fight antimicrobial resistance in the environment across the food supply chain.
  • Identifying foodborne antimicrobial-resistant bacteria, including Salmonella and Campylobacter, in all 50 states using whole genome sequencing, allowing for routine surveillance to predict antimicrobial resistance.
  • Protecting communities by stopping antimicrobial-resistant bacteria that cause foodborne outbreaks.
• Providing veterinarians and food animal producers tools, information, and training to improve antibiotic and antifungal use and infection prevention, such as working with partners from the Ohio State University and calf producers to increase producer awareness and use of educational materials.

Companion animals

CDC supports prevention and containment of AR in companion animals by:

• Supporting research to better understand and improve the use of diagnostics in veterinary care.

Improving our understanding of the human microbiome

CDC supports prevention and containment of AR through understanding of the human microbiome by:

• Identifying and sharing effective public health approaches to protect people's microbiomes (a community of naturally occurring germs in and on our bodies). For example, CDC and NIH co-edited a supplement issue in the Journal of Infectious Diseases (JID) titled The State of Microbiome Science at the Intersection of Infectious Diseases and Antimicrobial Resistance.
• Studying the connection between antibiotics and microbiomes, including new ways to protect and restore the microbiome.
• Determining how exposure to antibiotics early in life affects microbiome development.
• Developing a predictive index that identifies a patient's risk of disruption from a specific antibiotic, a patient's likelihood of becoming a carrier of antimicrobial-resistant germs, and their risk of becoming infected with one.
• Developing microbiome measurements to monitor a patient's risk for carrying and spreading antimicrobial-resistant germs.
• Improving strategies to tailor antibiotic use to a patient's individual microbiome and to a specific population of patients (like a nursing home or doctor's office).

Antibiotic/antifungal use

CDC strengthens prevention and containment of AR through antibiotic and antifungal use by:

• Collaborating with states to improve antibiotic and antifungal use across healthcare settings, including telehealth, dental settings, outpatient settings and STD clinics, and communities.
• Providing evidence and tools for facilities to implement antibiotic and antifungal stewardship practices and programs.
• Identifying new strategies and techniques for improving antibiotic and antifungal use.
• Using CDC's Antibiotic Stewardship Core Elements to implement antibiotic stewardship programs in outpatient and other community settings.
• Assessing how antibiotic use programs can be optimized to improve patient safety.

Vaccines, therapeutics and diagnostics

CDC is strengthening prevention and containment of AR through vaccines, therapeutics and diagnostics by:

• Adding new lab samples and isolates (pure samples of a germ) to the CDC and FDA AR Isolate Bank to support researchers in developing new diagnostics and more treatment options.
  • Delivering more than 325,000 germ samples to diagnostic test makers, academic researchers, and drug companies. Released a scientific report in 2018 on the science and research needs to address resistance in the environment.

• Supporting vaccinations for specific pathogens to prevent infections in the first place and reduce the need for antibiotics.
  • Decreasing strains of invasive pneumococcal infections by 97% in children since a vaccine was introduced in 2000 because CDC was able to use data from the Emerging Infections Program to encourage the importance of vaccines to achieve high vaccination coverage and encourage appropriate antibiotic use to slow the spread of pneumococcal resistance to the public.

Supporting innovation with partners

CDC combats AR with partners by:

• Supporting innovative approaches to developing and deploying diagnostic tests and treatment strategies to address antimicrobial resistance in the community through Broad Agency Announcements.
• Identifying gaps in knowledge related to resistance, the environment, and human and animal health to implement new ways to prevent antimicrobial-resistant infections and their spread.
• Working with partners to discover, implement and evaluate innovative strategies to improve healthcare quality, infection prevention and patient safety.
• Investigating the role of premise wastewater plumbing, such as sink basins and faucets, in healthcare facilities in the spread of antimicrobial-resistant germs into patient-care areas.
• Working directly with hospitals and clinicians, academic institutions, patients, private industry and clinical and public health partners to advance research and innovation.
• Collaborating with partners on innovative projects to make health care safer, including through Modeling Infectious Diseases in Healthcare Network (MIND-Heathcare), Safety and Healthcare Epidemiology Prevention Research Development (SHEPheRD), and Prevention Epicenters Program.

Building local, regional, national and global capacity

U.S local, regional, national efforts

CDC supports building local, regional and national lab capacity by:

• Increasing CDC's investments in state and local infrastructure to address antimicrobial resistance locally.
• Expanding domestic capacity to fight antimicrobial resistance in the environment and across the food supply chain, including:
  • Identifying foodborne antimicrobial-resistant bacteria, including Salmonella and Campylobacter, in all 50 states using whole genome sequencing, allowing for routine surveillance to predict antimicrobial resistance.
  • Protecting communities by stopping antimicrobial-resistant bacteria that cause foodborne outbreaks.

CDC's AR Lab Network

• Supporting nationwide lab capacity through CDC's AR Lab Network to detect antimicrobial resistance rapidly and inform local responses to prevent spread and protect people by:
  • Providing technical expertise including developing new tests, guidance and tailored solutions.
  • Supporting prevention experts, programs and training.
  • Reporting critical findings to international partners.
  • Providing cutting-edge technology, like whole genome sequencing.
  • Performing more than 800,000 tests to track antimicrobial resistance and sent 29,000 alerts about unusual AR, many of which required a public health response since 2016.
  • Sequencing nearly 38,000 gonorrhea and tuberculosis isolates (pure samples of a germ) providing a better understanding of the threats to help prevent spread since 2011.

Global efforts

• Growing CDC's Global AR Lab and Response Network, to improve the detection of existing and emerging antimicrobial resistance threats outside of the U.S.
• Contributing to the development and implementation of national action plans to address antimicrobial resistance.
• Improving international collaboration and capacities for prevention, surveillance and infection control, including providing CDC infection control technical assistance.
• Implementing programs in healthcare settings to prevent the spread of resistance, including infection prevention and control programs, water, sanitation and hygiene programs, and antibiotic/antifungal stewardship programs.
• CDC co-led The Antimicrobial Resistance Challenge, a yearlong effort by the U.S. government resulting in more than 350 organizations across the globe committing to take actions that will slow antimicrobial resistance.

How it's funded

In fiscal year 2016, Congress appropriated an unprecedented $160 million of new investments for CDC to fight antimicrobial resistance. With these investments, CDC implemented the AR Solutions Initiative to work toward meeting the national goals. This appropriation has increased to more than $197 million as of fiscal year 2023.

2022 Virtual public workshop co-sponsored by FDA & CDC

CDC and the Food and Drug Administration (FDA) co-sponsored a public virtual workshop on Tuesday, August 30, 2022. The title of the workshop was Drug Development Considerations for the Prevention of Healthcare-Associated Infections (HAIs). Discussions focused on the following topics/areas:

• The current state of development of pathogen-directed products used to prevent healthcare-associated infections.
• Evidence supporting decolonization and pathogen reduction (in colonized patients) as a strategy to prevent infection and transmission of antimicrobial-resistant healthcare-associated pathogens.
• Antimicrobial resistance threats as potential targets for decolonization and pathogen reduction.
• Challenges and potential approaches to drug development and registration of products for the prevention of healthcare-associated infections.

Drug Development Considerations for the Prevention of HAIs YouTube Video - 8:57

Resources

Combating Antimicrobial Resistance and COVID-19: Wastewater Surveillance YouTube Video - 1:57

In 2018, CDC funded the University of South Carolina to measure resistance genes in wastewater and in treatment plant workers at municipal wastewater treatment plants. When the COVID-19 pandemic started, CDC recognized that the research platform could also look for SARS-CoV-2 RNA (which carries genetic information) in wastewater.

Antibiotic Stewardship: Calf Producer Education YouTube Video - 2:02

Video highlighting Center for Disease Control and Prevention’s work with partners from Ohio State University and calf producers to increase producer awareness and use of educational materials.